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The clinical policy of the Emergency Medicine Association of Türkiye (EMAT) provides guidance on the use of tranexamic acid (TXA) in emergency settings. TXA, an antifibrinolytic drug, is used to control bleeding by inhibiting plasminogen. Its applications have expanded from hemophilia and severe menstrual bleeding to include various forms of trauma and surgery-related bleeding. Despite its potential benefits, the use of TXA in emergency settings must be carefully evaluated due to its associated risks, including venous thromboembolism. This policy aimed to offer evidence-based recommendations on the indications and contraindications of TXA in different clinical scenarios encountered in the emergency departments. The guidelines were developed using the "Grading of Recommendations, Assessment, Development, and Evaluations" approach, incorporating systematic literature reviews, and expert consensus from the EMAT Research Committee. This document focuses on critical clinical questions regarding the efficacy and safety of TXA in situations such as gastrointestinal bleeding, multitrauma, traumatic brain injury, nontraumatic intracranial hemorrhage, hemoptysis, and epistaxis. By addressing these issues, the policy seeks to assist emergency physicians in making informed decisions about the use of TXA, ultimately aiming to improve the patient outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Bosphorus Medical Journal / Boğaziçi Tıp Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectıve: Acute upper gastrointestinal system bleeding in patients presenting at the Emergency Department is a significant cause of morbidity and mortality. Different scoring systems have been developed for the evaluation in emergency department of patients with gastrointestinal system bleeding. Emergency endoscopy may not be possible in patients presenting to the emergency department with gastrointestinal bleeding. The aim of this study was to compare pre -- endoscopic scoring systems (Like the Glasgow Blatchford Score and the pre -endoscopic Rockall scoring systems) in patients presenting at the emergency department with upper gastrointestinal system bleeding, to determine high-risk patients and examine the efficacy of these systems in predicting 30-day mortality. Method: This prospective study included patients aged >18 years who presented at the Emergency department of XXX Training and Research Hospital between January 2014 and December 2014. Results: The study included a total of 101 cases with a mean age of 65.62 years (range, 19-97 years). Melena was determined in 45 (44.6%) patients, hematochezia in 25 (24.8%), hematemesis in 26 (25.7%), diarrhea and abdominal pain in 7 (6.9%) and syncope in 1 (1.0%). The mean Blatchford score of the patients was 10.56±3.75 (range, 3-19). According to this scoring system, 6 (5.9%) patients were at moderate risk, 18 (17.9%) at high risk, and 77 (76.2%) at very high risk. The mean pre -- endoscopic Rockall score was 3.11±2.37 (range, 0-9). According to this scoring system, 49 (48.5%) patients were at low risk, 22 (21.8%) at moderate risk, and 30 (29.7%) at high risk. Of the 49 cases identified as low risk with the pre- endoscopic Rockall classification, 4 were classified as moderate risk, 14 as high risk, and 31 as very high risk using the Blatchford scoring system. Of the 22 cases identified as moderate risk with the pre- endoscopic Rockall classification, 1 was classified as moderate risk, 2 as high risk, and 19 as very high risk using the Blatchford scoring system. Of the 30 cases identified as high risk with the pre -- endoscopic Rockall classification, 1 was classified as moderate risk, 2 as high risk, and 27 as very high risk using the Blatchford scoring system. The differences between the two scoring systems were determined to be statistically significant. No statistically significant difference was determined between the mortality rates of cases according to the Blatchford scoring (p>0.05). The difference between the mortality rates of the cases according to the pre -- endoscopic Rockall scoring was determined to be statistically significant (p=0.001, p<0.01). The mortality rate of patients at high risk according to the pre -- endoscopic Rockall scoring was determined to be higher. The difference between the mortality rates of the cases at high risk according to the pre- endoscopic Rockall scoring was determined to be statistically significant (p=0.001, p<0.01). The risk of mortality was determined to be 6.022-fold greater in cases at high risk according to the pe - endoscopic Rockall scoring. The odds value for preendoscopic Rockall scoring was 6.022 (95% CI: 2.148-16.882). Conclusion: The Blatchford and pre- endoscopic Rockall scoring systems were not seen to be consistent with each other and in the prediction of mortality, pre- endoscopic Rockall scoring was determined to be better. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Academic Emergency Medicine / Akademik Acil Tip Olgu Sunumlari Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Spontaneous pneumomediastinum was described by Louis Hamman in 1939. For this reason, it is named Hamman's syndrome. It often occurs in young patients. Patients frequently heal without any complications. Case Report: In this article, a case of spontaneous pneumomediastinum with atypical presentation is presented. Conclusion: Patients who are admitted to the emergency department with sore throat should be examined carefully, and spontaneous pneumomediastinum should be kept in mind in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Insulin glargine is a long acting novel recombinant human insulin analogue indicated to improve glycemic control, in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. The time course of action of insulins including insulin glargine may vary between individuals and/or within the same individual. Insulin glargine is given as a 24-h dosing regimen and has no documented half-life or peak effect. Hypoglycemia is the most common adverse effect of insulin, including insulin glargine. As with all insulins, the timing of hypoglycemia may differ among various insulin formulations. We present a case of a 76-year-old male insulin-dependent diabetic patient with refractory hypoglycemia secondary to an intentional overdose of insulin glargine. We would like to highlight the necessity of prolonging IV glucose infusion, for a much longer period than expected from pharmacokinetic properties of these insulin analogues after intentional massive overdose. [ABSTRACT FROM AUTHOR]